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NPI Code Detail

MEDICARE: DEREK JAMES FICKES DMD

MEDICARE: DEREK JAMES FICKES DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2122300000XDentist30.027190OH

General Provider Information

NPI Number : 1497445936
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK JAMES FICKES DMD
Provider Business Mailing Address
First Line : 12575 COLUMBIANA CANFIELD RD
Second Line :
City : COLUMBIANA
State : OH
Zip : 44408-9778
Country : US
Telephone Number : 330-501-4217
Fax Number :
Provider Business Practice Location Address
First Line : 309 S CHAPEL ST
Second Line :
City : LOUISVILLE
State : OH
Zip : 44641-1612
Country : US
Telephone Number : 330-875-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2023
Last Update Date : 07/23/2023

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Directions to “ DEREK JAMES FICKES DMD” Practice Location

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